Why are self-medication opportunities limited in Austria? An interview study and comparison with other countries.

BackgroundAustria has high health resource use compared to similar countries. Reclassifying (switching) medicines from prescription to non-prescription can reduce pressure on health resources and aid timely access to medicines. Since Austria is less progressive in this area than many other countries, this research aimed to elucidate enablers and barriers to it reclassifying medicines and make recommendations for change in the context of similar research conducted elsewhere.MethodsQualitative research using a heuristic approach was conducted in Austria in 2018. Informed by their own "insider" and "outsider" knowledge, the authors identified themes from personal interviews with 24 participants, including reclassification committee members, government officials and stakeholders, before comparing these themes with earlier research findings.ResultsSignificant barriers to reclassification included committee conservatism, minimal political support, medical negativity and few company applications. Insufficient transparency about committee decisions, expectations of adverse committee decisions and a limited market discouraged company applications. Austria's 'social partnership' arrangement and consensus decision making aided a conservative approach, but the regulator and an alternative non-committee switch process were enabling. Pharmacy showed mixed interest in reclassification. Suggested improvements include increasing transparency, committee composition changes, encouraging a more evidence-based approach by the committee, more pharmacy undergraduate clinical training, and companies using scientific advisory meetings and submitting high quality applications.ConclusionRemoving barriers to reclassification would facilitate non-prescription availability of medicines and encourage self-care, and could reduce pressure on healthcare resources

Barriers in Australia and New Zealand for switches (based on interview data).

<p>Barriers in Australia and New Zealand for switches (based on interview data).</p

Advertising decisions in Australia for pharmacist-only medicines 2000–2011.

<p><b>Source</b>: Therapeutic Goods Authority records. Some medicines appear multiple times, e.g. proton pump inhibitors from 2009.</p

Outcomes of ‘progressive’ switches considered in New Zealand in 2000–2011.

<p>Source: Medicines Classification Meeting minutes. Medicines were counted once per period, regardless of the numbers of considerations for each medicine. The Medicines Classification Committee had three members change in 2004.</p

Usual lines of inquiry.

<p>Usual lines of inquiry.</p

Key reasons for Trans-Tasman variation.

<p>Key reasons for Trans-Tasman variation.</p

Enablers in Australia and New Zealand for switches (based on interview data).

<p>Enablers in Australia and New Zealand for switches (based on interview data).</p

Financial influences on switch in New Zealand.

<p>Financial influences on switch in New Zealand.</p

Outcomes of ‘progressive’ switches considered in Australia in 2000–2011.

<p>Source: Therapeutic Goods Authority records. Medicines were counted once per period, regardless of the numbers of considerations for each medicine. Tranexamic acid reclassified in 2000 but was reversed in 2007 when no non-prescription product had been marketed.</p

A comparison of the heuristic approach used versus the standard heuristic approach[26,27].

<p>A comparison of the heuristic approach used versus the standard heuristic approach[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0119011#pone.0119011.ref026" target="_blank">26</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0119011#pone.0119011.ref027" target="_blank">27</a>].</p